Evaluating Mental Disorder Case Studies Case Study

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Mental Illness from a Counselor's Perspective

Alcohol Dependency in Women

Symptoms of Alcohol Dependency

Alcohol dependency or alcoholism is suspected when persons appear to be preoccupied by the consumption of alcoholic beverages (Johnson, 2003). The three prototypical markers of alcohol dependency are a loss of control over the consumption of alcohol, preoccupation with alcohol consumption, and the use of alcohol despite adverse affects on the person's quality of life. For example, Elaine Gustafson was disturbed by her inability to have just a few drinks. According to her, when she went out with friends they would have two to three drinks and she would invariably consume over a dozen drinks until she was drunk.

Effects of Illness

The social consequences of alcoholism differ between men and women, with men typically incurring less condemnation (Johnson, 2003). A drunk male is generally seen as out having a good time, but a drunk female is often characterized as a bad person and sexually promiscuous. This may help explain why 75% of all sexual assaults involve alcohol. In addition, when men and women drink equivalent amounts of alcohol the outcomes differ. Women will become inebriated quicker and symptoms will persist longer. The physiological consequences of long-term exposure to alcohol differs substantially, as well, with organ damage occurring for women with just two glasses of wine per day, compared to six for men. The main organ affected is the liver, but the cardiovascular and nervous systems are also negatively affected. Other problems may manifest, including vitamin deficiencies and cancer. The risk of death is also twice as high for women compared to men. The gender difference in alcohol susceptibility is due in part to women having less water in their bodies to dilute the alcohol and producing less alcohol dehydrogenase enzyme in their stomachs to metabolize ingested alcohol. Women suffering from alcohol dependence are therefore more susceptible to negative health and behavioral outcomes when compared to men.

Alcoholic families can still be socially successful, but the negative consequences will affect all family members (Johnson, 2003). Women who become pregnant and continue to consume alcohol may give birth to children with birth defects. For example, Cathy Mitchell gave birth to five children while she continued to drink. Accordingly, one infant died shortly after a premature birth and another died of Sudden Infant Death Syndrome (SIDS) a few months after birth. Her oldest child suffers from Fetal Alcohol Syndrome (FAS), but Cathy only became aware of this fact after her child reached adulthood. Other disorders related to alcohol exposure during pregnancy include autism spectrum disorders, attention deficit hyperactivity, borderline personality, depression, mental retardation, oppositional-defiant disorder, posttraumatic stress, and receptive-expressive language disorder.

Counseling Interventions

Counseling is an important component of recovery from substance abuse, including alcohol dependence (Marsh, Dale, & Willis, 2007). The three main symptoms of alcohol dependence discussed above, loss of control, preoccupation, and denial, are all amenable to counseling interventions. Of primary importance is the ability of the therapist to quickly establish a therapeutic alliance with the client. Doing so requires the therapist to become a recovery advocate for the client. Another important role is that of educator, thereby helping patients understand alcohol dependency and how to begin and maintain recovery. The video featuring Cathy Mitchell devotes a considerable amount of time to explaining how she was never told that alcohol was more damaging than the opiate drugs she had been taking, especially to fetuses (Johnson, 2003). Although less relevant to the two women featured in the video, therapists should work to ensure that the basic needs of clients are being met, such as food, shelter, and safety, because alcoholism is not uncommon among the homeless, poverty stricken, or domestic abuse victims. When this situation arises the therapist takes on the role of social worker and helps clients find and access the social services needed to resolve these issues. Once these basic needs are met, the work of recovery from alcohol dependency will be that much easier to accomplish. The therapist may also need to evaluate the overall physical and mental health of clients and provide referrals as needed to address comorbid conditions.

Treatments and Supports

Once Elaine Gustafson accepted the possibility that her alcohol dependency was destroying her life, rather than holding it together, she began to attend alcoholic anonymous meetings (Johnson, 2003). This step helped her realize that she was not alone in her struggles with addiction or the only one living the life of an alcoholic.

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She also learned that stress was a trigger for alcohol consumption and began to engage in effective stress management techniques, including exercise. Elaine also learned to be comfortable spending time alone with herself and gradually became comfortable with the person she became when sober. Cathy Mitchell began her path to sobriety by moving into a residential recovery program for a year away from her family and then spent another year reengaging with her family while remaining in the residential recovery program. These approaches to recovery seemed to work well for these two women. A key element of recovery for both women was becoming educated about the negative effects of alcohol dependency, not only for themselves, but for their children and families.

Finding the Line between Health and Illness

The CAGE test was discussed in the video, which helped identify whether someone may be suffering from alcohol dependency (Johnson, 2003). If a person has ever felt that they should cut back on their drinking, then they have met the "C" diagnostic criteria. If they have been annoyed by anyone criticizing their drinking, this meets the "A" criteria. Feelings of guilt about drinking or needing a drink first thing in the morning would fulfill the last two criteria of the CAGE test. The more of these criteria a person answers yes to, the more likely they may be suffering from alcohol dependence. The diagnostic criteria recommended by the American Psychiatric Association (APA, 2013) are similar and alcohol use disorder is diagnosed when an individual meets only 2 of the 11 criteria within the past 12-months. The diagnostic criteria include loss of control over drinking, preoccupation with alcohol consumption, and denial of a drinking problem, in addition to alcohol consumption interfering with the ability to meet work, school, or family obligations. Cravings, tolerance, and withdrawal are also diagnostic criteria.

Teen Anxiety Disorder

Symptoms

Based on the video from Alexander Street Press (2008), teen anxiety disorder manifests when a pre-teen or teenager experiences constant fear, doubts, and insecurities to the point that it interferes with their ability to function at school or socially and may elicit other serious health problems, such as major depression. From a clinical perspective, these symptoms fit within social anxiety and general anxiety disorders. Clinically-relevant social anxiety can involve an extreme fear or anxiety about being judged negatively by others or making a social mistake that leads to embarrassment. General anxiety disorder, by comparison, consists of chronic worrying about any number of issues, such as those associated with family, health, or academic performance, or may involve a more general concern, such as the threat of terrorism. In contrast to the fears, doubts, and insecurities that accompany the lives of normal adolescents, teen anxiety disorder is not transient and requires treatment by mental health professionals.

The main symptoms that parents may notice include their child avoiding social and school activities (Alexander Street Press, 2008). If this behavior can be verified, then parents may notice that their child is gradually eliminating social activities from their life, alienating friends, and putting the burden of engaging socially on everyone else's shoulders. Another telling sign of teen anxiety disorder is that a child's hesitancy to engage in social activities is refractory to attempts to reassure the child. More generally, parents should be concerned if their child experiences changes or problems with eating, sleeping, schoolwork, general activity levels, mood, relationships, and aggressive behavior, especially if these changes appear to be more than transient.

Effects of Teen Anxiety Disorder

In the Alexander Street Press video (2008) the symptoms of Mia DeSimone were described. These symptoms included her feeling like she didn't fit in socially and these feelings worsened in larger social gatherings, leaving Mia to feel that she could never relax. As Mia approached puberty, physical symptoms began to manifest, including stomach aches, sweating, throat constriction, and ringing in the ears. Spending time at a friend's house would often result in a phone call from Mia asking to come home and when she did return appeared traumatized by the experience. When sitting in classrooms Mia would occasionally experience mental detachment (derealization) or upon waking in the morning begin crying, sweating, experiencing chest pains, shortness of breath, or stomach pains.

These symptoms naturally elicited parental concern, but lacking an understanding of the source of this anxiety, frustration would result (Alexander Street Press, 2008). Some parents will react by becoming overprotective and attempt to ensure their child never experiences anything negative......

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