The massive actual and propaganda warfare being waged in the USA has generally concealed the fact that alcohol abuse is one of the greatest psychological problems in the USA. Over and above the deaths and health issues related to too much drinking, drunk driving related accidents are one of the greatest killers in the country. Yet alcohol is free, easily accessible and well publicized providing an opening avenue for the problem to exacerbate (Lewis, Dana & Blevins, 2014). The taking of alcohol per se does not amount to a psychological issue. However, in 2013, the abuse of alcohol was finally recognized as a diagnosable psychological disorder referred to as alcohol use disorder as well as alcohol dependence (Riper et al, 2014). Three categories of people are highly susceptible to alcohol abuse. The first is the pleasure-long groups who enjoy spending too much time in clubs and parties and therefore end up drinking too much too frequently. The second group relates to those with a high propensity for anxiety thus drinking continually or sporadically to avoid or forget the anxiety. Finally, there is the binge drinkers group which mainly consists of teenagers and young adults (Riper et al, 2014). These are individuals with a high propensity of drinking too much alcohol as a habit continually or sporadically. All these individuals are in dire need of counselling for the reasons that cause them to drink, for the damage they have caused to themselves and others due to drinking as well as for the long and difficult journey of quitting drinking and maintaining it.
Why Therapy Should Be Provided to Alcohol Abusers (Personal Perspective)
It is easy and indeed probable to condemn alcohol abusers as the authors of their own misfortune who do not deserve sympathy. It has also been argued that the massive resources made available to alcohol abusers like hours of professional therapy, beds in rehabilitation centers and medication would better be expended for more deserving patients. This is exacerbated by the fact that the profession of counselling is in many ways a calling over and above simply a professional affiliation since it rises beyond the simple art of curative science. This makes the argument on whether or not alcohol abusers, some of whom cannot even afford the services offered should be accorded counselling, care and help. However, nobody wakes up one day and decides to become an alcoholic.
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Many alcoholics are victims of a habit that developed gradually and finally got out of hand. Others are teenagers and young adults who should have known better but did not and are in the process of ruining their lives. Yet others were victims of catastrophic life changing events such as accidents or loss of loved ones which triggered the harmful habit. Most importantly, anyone is susceptible either to alcohol abuse or having a loved one who is an alcohol abuser. The totality of the above makes alcohol abusers victims not perpetrators who deserve help not condemnation. In helping one alcohol abuser, scores of loved ones and/or potential victims are contemporaneously being helped too.
The Processes of Assisting Alcohol Abusers
The CAGE questionnaire is the commonly used form of diagnosis for anyone suspected to be abusing alcohol. Over and above being a diagnosis tool, CAGE also creates an understanding of what is wrong about alcohol abuse and why counselling is necessary (Riper et al, 2014). The first Letter is based on cutting drinking and regards the amount of alcohol being consumed. The second refers be Annoyance by third parties and relates to effects of alcohol abuse on third parties including loved ones. The third letter relates to feeling guilty about drinking and regards a personal condemnation (Riper et al, 2014). The final letter relates to the eye-opener drink to wit overreliance of alcohol and inability to stop or control the habit. Counselling is meant to help abusers deal with all these internal and external issues (Riper et al, 2014).
The fundamental point of commencement in alcohol abuse counselling is establishing why the individual has ended up becoming an alcohol abuser. Most alcohol abusers as aforesaid are teenagers and young adults. Their reasons for drinking may stem from childhood issues or issues they are going through at the time (Riper et al, 2014). Understanding the issue, facing and overcoming it is an important way of overcoming the psychological impact thereof (Lewis, Dana, & Blevins, 2014). This will reduce the propensity to drink. Once the issues have been solved or alongside solving the issue, the second part of counselling is to control the drinking itself.
The intended goal of alcohol abuse counselling is to completely eliminate the habit of drinking (Riper et al, 2014). In many cases, this may not be possible in the first instance and insistence may cause an abuser to abandon drinking completely and immediately (Lewis, Dana, & Blevins, 2014. Therefore, the initial approach, referred to as moderation involves trying to have the alcohol abuser drink less gradually until full cessation of drinking is achieved. The key to moderation and final cessation of drinking lies in the mind and this should be the point of focus for the therapist (Lewis, Dana & Blevins, 2014.
The hardest part for any alcohol abuser is avoiding recurrence which is a lifelong journey. This is exacerbated by the fact that most abusers are young as aforesaid thus elongating the duration of avoiding recurrence. The most common and effective method of avoiding recurrence is Cognitive-Behavioral Therapy (CBT) (Riper et al, 2014). This is a form of psychotherapy that takes a practical approach to solve problems. An alcohol abuser has a myriad of problems including the reason for drinking, the drinking itself, damage caused by drinking, and propensity for recurrence (Riper et al, 2014). If any of these problems is not properly handled, the overall problem has not been solved and any solution arrived at is temporary. Through individual and group therapy, an abuser is assisted to take practical steps in handling, managing, and overcoming the set of problems as aforesaid. Caring, tolerance and patience are however fundamental for the carrying out of the obligations relative to alcohol abuse counselling.
Ethical Issues Involved
As indicated above, from a casual approach, alcohol abusers do not seem to be the most deserving of assistance. Whereas they are in dire need of help, their capacity for cooperation with the therapist, following instructions and adhering to regimens agreed upon is diminished (Lewis, Dana, & Blevins, 2014. Further, these individuals have been judged and condemned by others even as they have been condemning themselves (Moyer, 2013). This creates a very high propensity for being defensive and easily taking offense more so when the client happens to be young. It is easy for the therapist to be overtaken by distaste for the client just like everyone else including loved ones are, entirely due to the conduct of the client. This calls for adherence to article A1.a of the Association of counsellor’s code of ethics and remain professional premised on the understanding that the primary obligation is to the welfare of the client (Riper et al, 2014).
A more complicated ethical obligation pertinent to counselling for alcohol abusers is the duty to protect and warn. Alcohol impairs judgment and causes impairment even upon the most skilled (Moyer, 2013). It is on this premise that pilots and other high risk professionals such as train drivers undergo continued testing to ensure that they are not abusing alcohol or drugs. However, other professions such as a driver of a public vehicle or truck can cause grave danger if their senses are impaired by alcohol abuse (Moyer, 2013). When this information reaches a counsellor in the course of therapy, it creates an obligation to warn those susceptible of the imminent danger. This warning however will create a breach of the fundamental ethical obligation of confidentiality (Moyer, 2013). Further, the warning will most likely end the counselling relationship leaving the client unassisted.
Whereas the decision may be in danger when public safety is an issue, private safety of people close to the loved ones is crucial (Lewis, Dana, & Blevins, 2014. This is easier on issues such as neglect and abuse of minors as reporting becomes an immediate obligation. However, if a male client who in drunken stupor engages in risky sexual behavior such as unprotected homosexual liaisons risks infection from himself and the spouse. A counselor who happens to know this and also knows that the wife does not suspect it, will have a major ethical dilemma of whether or not to inform the wife. A police officer who admits to get drunk while armed on duty or a licensed gun owner who gets drunk while carrying a concealed weapon would create the same dilemma. Unfortunately, in alcohol based counselling, this dilemmas are the norm rather than the exception.
Conclusion
Alcohol abuse is a serious problem in the contemporary times more so in the USA having ravaged a substantial cross section of teenagers and young adults. Not only does it cause direct medical and psychological problems but also leads to impaired judgment with adverse consequences such as traffic accidents. It is however important for a therapist to avoid perceiving alcohol abusers as authors of the own misfortunes, albeit sometimes they are. By the time an individual reaches the point of diagnosis for alcohol abuse, they are already ridden with guilt and surrounded by condemnation. The CAGE questionnaire provides a simple and important diagnosis tool for alcohol abusers. Upon diagnosis, it is important to understand the cause of the abuse and handle it even as the abuse itself is being handled. Further, the avoidance of recurrence of the habit is even more important as it is a long term issue. Ethics are an important aspect of alcohol counselling albeit the duty to warn and/or protect creates complex ethical dilemmas. Indeed, counselling is an important weapon in combating the scourge of alcohol abuse in America.
References
Lewis, J. A., Dana, R. Q., & Blevins, G. A. (2014). Substance abuse counseling . London: Cengage Learning
Moyer, V. A. (2013). Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: US preventive services task force recommendation statement. Annals of internal medicine , 159 (3), 210-218.
Riper, H., Andersson, G., Hunter, S. B., Wit, J., Berking, M., & Cuijpers, P. (2014). Treatment of comorbid alcohol use disorders and depression with cognitive ‐ behavioural therapy and motivational interviewing: A meta ‐ analysis. Addiction , 109 (3), 394-406.
