Addictive Behaviour Case Study
A 35 year old married man called Mr D was brought to hospital by ambulance. His colleagues at the bank where he works as a financial advisor had found him slumped over his desk. He had drunk a whole bottle of vodka. He had vomited profusely and was nearly unconscious.
Significant results of physical investigations:
- WCC - 6.2 ( 4.0-11.0 x 109/l)
- MCV - 108 ( 76-96 fl)
- GGT - 140 ( 11-51 IU/l)
- AST - 211 (5-35)
- ALT - 97 (5-35 IU/l)
He was admitted to a medical ward and seen the next day by the duty psychiatrist who noticed Mr D was shaking all over and perspiring. He kept wringing his hands and seemed very anxious.
At interview, he gave a history of heavy drinking for the past 8 months since his manager set new targets for the department. The drinking had caused many arguments with his wife which had culminated in her leaving with their 2 children to stay with her parents.
The psychiatrist inquired about other symptoms and learnt that Mr D felt he had lost control of his drinking and felt unable to stop. He spent as much time as possible drinking to cope with stress and always had a drink first thing in the morning to give him a lift before going to work.
Explain the underlying clinical phenomena.
He is an alcoholic
- Detox them; get them clean, and deal with DTs
- Group Therapy; Get them to join AA
- Drug Therapy; put them on antabuse, which makes them feel terrible if they drink
Describe the features of a dependence syndrome (including alcohol)
Using stamp collecting as an example:
- Primacy: The hunt for stamps begins to take priority over other activities. It becomes a compulsion.
- Narrowing of Repertoire: The addict begins to stick to one staple, such a second class, or whisky.
- Tolerance develops: so it takes more stamps to satisfy.
- Rapid Reinstatement after Abstinence: After just a few day clean, the addict heads back down to the Post Office...
- Withdrawal symptoms: such as anxiety and tremor develop after a short period without a a quick "first class" hit, and are only reduced by buying more stamps.
Know the commonly abused substances and understand their effects
- Opiates: Heroin, Methadone, Codeine, Morphine and Opium. Main effect is euphoria. Apparently, its rather good.
- Stimulants: Cocaine, Crack, Ecstasy, Amphetamine. Hyperactivity, euphoria, aggression.
- Hallucinogens: LSD, Magic Mushrooms. Marked perceptual disturbances, crazy ideas.
- Weed: "Woah! Gets you stoned man..."
Know how to take an alcohol history
- How much do you drink?
- What do you drink?
- Who do you drink with?
- Are you worried/has anyone ever commented about your drinking?
- Do you have a problem if you try to stop drinking?
- Do you need an eye opener in the morning?
- If you have one drink, do you have to keep drinking?
Understand the terms tolerance and withdrawal
Tolerance: The addictive substance has less effect; more is needed than previously to maintain the same degree of intoxication
Withdrawal: Feelings of discomfort, distress, and intense craving for a substance that occur when use of the substance is stopped
- Compulsion to drink
- Withdrawal symptoms
Describe the epidemiology of substance abuse (including alcohol)
1/3 of the population abstain from alcohol, 1/3 drink lightly and 1/3 drink heavily.